Q~~I have a question that may be a sensitive one regarding Selective Reduction. Who makes the reduction decision? (where there are no medical issues compelling a reduction)Can the IPs and surro make the decision together? Wat if they disagree? It's her body but it's our baby - such a difficult issue. ~EM
A~~ Selective Reduction should be talked about before the first transfer takes place and it is often mentioned in the contract as either something that would be considered and what the fee for the surrogate (for recovery, pain and suffering) would be if she had to endure such a procedure. Your RE/Clinic should have the discussion when first meeting a surrogate as well. If she is petite and obviously would have a physical problem carrying anything over triplets then they may highly recommend that you reduce anything over twins. Even if the RE only transfers 2 embryos they could split into triplets or more. It seldom happens but its always good to be aware. So for the health of the surrogate, Selective Reduction could be highly recommended under those circumstances.
Another issue would be what the Intended Parents want to raise. They may not be financially or emotionally capable of raising more then twins (and I am using twins here because it is very rare for twins to be reduced down to a single fetus because the entire pregnancy could be lost). If the Intended Parents are set on having no more then twins, they have to find a like minded surrogate that doesn't have a religious or ethical issue with selective reduction.
The bottom line here is that the surrogate can change her mind in either case. She can decide that she isn't able to selectively reduce when she is faced with the actual fact of multiples and decides to carry them even against Dr. orders or what she previously agreed to in the contract OR she decides not to selectively reduce because of a change of heart and the reality of an abortion is too hard for her to consider. On the other hand she may keep the entire pregnancy even against the 'carrying more then twins' issue as stated in the contract when faced with a 'litter' of babies and considering all health risks, continues to want to keep the pregnancy in tact, although at the time of the contract she was sure that she would want to reduce. In either case it is ultimately her decision as Selective Reduction is, in reality, abortion and any pregnant woman has the right to choose under Row vs Wade.